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Idiopathic intracranial hypertension (IIH) affects both children and adults. Whilst the majority of IIH is mainly seen amongst adults, it also affects children. There are currently no clinical trials in IIH for those who are adolescents or children. The aims of this narrative review were to characterise the differences between pre- and post-pubertal IIH and to highlight the need to be more inclusive in clinical trial planning and recruitment. A detailed search of the scientific literature was performed using the PubMed database up until 30 May 2022, revealing that the pre-pubertal group had a more variable presentation. The presenting features in the post-pubertal paediatric group were more akin to adults with headache as the dominant feature. They were also more likely to be female and have an increased body mass index. A clear limitation of the literature was that several paediatric studies had variable inclusion criteria, including secondary causes of raised intracranial pressure. Pre-pubertal children do not display the same predilection towards the female sex and obesity as post-pubertal children, who have a similar phenotype to the adult cohort. Inclusion of adolescents in clinical trials should be considered given the similar phenotype to adults. There is a lack of consistency in the definition of puberty, making the IIH literature difficult to compare. Inclusion of secondary causes of raised intracranial pressure has the potential to confound the accuracy of analysis and interpretation of the results.

Different characteristics of pre-pubertal and post-pubertal idiopathic intracranial hypertension: a narrative review.
Lyons HS, Mollan SLP, Liu GT, et al.
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Claire Howard

Salford Royal NHS Foundation Trust, Salford, UK.

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